Investigating Workload and Occupational Burnout of Healthcare Workers in the Welfare Organization of Gonabad City

Investigating Workload and Occupational Burnout of healthcare workers in the Welfare Organization of Gonabad City

RAZZAGH RAHIMPOOR1, MOHAMMAD JAVAD FANI2, MARYAM ISMAILI3, MARYAM FRAIE3, FATEMEH ALI NEJAD3, and ALI FIROOZI CHAHAK2*

1PhD Student in Occupational Health, And Safety Engineering, Department of Occupational Health, School of Public Health, Hamadan University of Medical Science, Hamadan, Iran; 2 Faculty Member, Dept. of Occupational Health, Faculty of Health, Gonabad University of Medical Sciences, Gonabad, Iran; 3Student in Occupational Health, Student Research Committee, Gonabad University of Medical Sciences, Gonabad, Iran

Received March 07, 2017; Revised December 20, 2017; Accepted February 21, 2018

This paper is available on-line at http://ijoh.tums.ac.ir

ABSTRACT Workers in welfare centers have to work more than other people, which may lead to job burnout. The present study was conducted to analyze the relationship between workload and burnout dimensions among the employees in health centers of Gonabad City, eastern Iran. In this descriptive-analytic study, a total number of 100 healthcare workers from the Welfare Organization of Gonabad City were selected to investigate the association between their workload and occupational burnout using the NASA-TLX questionnaire and the Maslach-Jackson Inventory. The data were analyzed by Chi-square, Pearson correlation, and one-way ANOVA in SPSS 22 software. Among the healthcare workers of the Welfare Organization, nurses had the highest rate of burnout in terms of efficiency (67.9±21.3). They had the lowest rate of burnout in terms of exhaustion and frustration (37.05±24.23), and moderate burnout in terms of mental pressure, physical pressure, time pressure, and effort (63.40± 26.17, 58.75±23.78, 60.30±21.72 and 61.54±26.31). Considering the findings of the study and the importance of the health care profession, it is of the utmost importance to address the problems of healthcare workers in the Welfare Organization. Accordingly, the authorities must take the necessary steps to suit the environmental, managerial, and personnel conditions to them.

KEYWORDS: Welfare Organization, workload, occupational burnout, Healthcare workers

INTRODUCTION Recent studies show that in the event of Workers are an inevitable necessity for the disregard for human health, workplaces become as survival of society and continuation of life. places most at risk for employees and besides, Furthermore, every person's life is fulfilled through impose a heavy cost on organizations [3]. From the work and self-sufficiency of each country depends on perspective of ergonomic science, the most the amount and type of performance of its employees important factor in the occurrence of occupational [1]. Being in the workplace and devoting a significant accidents and injuries is the disproportion between amount of time to work and mentally worrying about the workload and workers’ abilities and limitations work activities has led many to voluntarily spend a lot [4]. Human resources, compared to other resources, of time on work activities without having sufficient are the most valuable strategic resource for any rest and time to spend with family and friends, which organization that can be the source of changes in often cause mental and physical problems [2]. the systems [5]. In the meantime, the health sector Occupation and workplace are one of the social is one of the most important organizations in the factors affecting mental health. world; therefore, there is a need to pay attention to different aspects of its workers [6-7]. Undoubtedly, Corresponding author: Ali Firozi Chahak many occupations are "stressful" and workers Email:[email protected] usually do not know how to stay away from these

Investigating Workload and Occupational Burnout … ijoh.tums.ac.ir | 47 kinds of stresses and protect themselves from According to Gaba Wali (1995), assessing injuries, so some of them are constantly stressed the amount of work in nursing is essential because out because of enduring the stress or weakness the stressors that are so prevalent in the job can caused by coping with these tensions [2, 8]. affect the management of high workloads. In Occupational burnout can be a addition, the high volume of tasks and their consequence of working in organizations that is a compliance with supervisory needs in nursing may negative aspect of work-life [9]. The concept of reduce the recognition and response to emergencies occupational burnout was first introduced by [11, 24]. In a study by Malekpour et al. (2014) on Freudenberger in 1974 as a form of exhaustion and the assessment of mental workload among Iranian frustration due to the communications and business nurses, the mean score of mental workload was relationships that does not lead to the desired found to be high among nurses. This could outcomes. Occupational burnout syndrome, which negatively affect the quality of the health care occurs in response to the working burden, is services provided by them. Accordingly, it was defined as a process in which employees' attitudes recommended to implement effective programs to and behaviors become negative and pessimistic mitigate the mental load to improve the nurses' towards their work [2, 10]. performance [25]. Therefore, assessing the Occupational burnout includes three workload of nurses is essential to ensure the perspectives of emotional exhaustion, provision of appropriate healthcare services. This depersonalization, and personal accomplishment. assessment is important not only for the health of The emotional exhaustion is described as nurses, as a valuable force in medical care, but also psychological stress, emotional stress and loss of for the health of patients in terms of the emotional resources in a person [11]. The performance of healthcare workers. depersonalization is a negative and pessimistic The employees in the Welfare attitude toward others and clients. A decline in Organization have a very difficult job because of personnel’s self-accomplishment is also a decline providing services to people with poor financial, in the sense of merit and the ability to perform a physical, and mental health status. The employees task successfully, as well as a negative attitude and have a high workload and burnout. The purpose of assessment towards oneself [12-13]. This syndrome this study was to determine the rate of workload is defined as a disability in the long-term and prevalence of burnout among the healthcare adaptation/exposure to emotional/working stress or workers of the Welfare Organization in Gonabad frequent use of energy and resources leading to the City and to investigate the relationship between feeling of failure, declination, and exhaustion [14]. these two variables. In a review study by Yaman et al. on occupational burnout of healthcare workers, it was shown that MATERIALS AND METHODS depression, burnout, and psychosomatic disease This cross-sectional (descriptive-analytic) among healthcare workers are due to the nature of study was conducted in 2016 to assess the their occupation. Interventions to the individual, by workload and occupational burnout among the the inclusion in the institutional management in healthcare workers of the Welfare Organization in addition to institutional improvements, may help Gonabad City, eastern Iran. To this end, all of the prevent burnout [15]. healthcare workers of the organization were Workload, as a multidimensional and included in the study. Totally, 100 workers were complex structure, is affected by the external needs entered the study according to the inclusion criteria of the task and environment, as well as of at least one year of work experience, not organizational and mental factors [16], such as working two jobs, no alcohol addiction, and no administrative and cognitive capabilities [17]. The history of musculoskeletal disorders and mental workload in healthcare centers is not limited to and emotional diseases. The data on the physical tasks. The cognitive tasks may also be part occupational burnout were collected by Maslach- of the complexity of the overall workload endured Jackson Inventory and on the workload by NASA- by healthcare workers [18, 19]. Workload TLX [26]. The burnout questionnaire was addresses a set of job requirements, the amount of developed by Maslach in 1981, which is a new effort required to perform the work and the estimate of the stress phenomenon i.e. burnout. The efficiency and performance of workers [20-21]. questionnaire consists of 22 sections dealing with One of the factors that currently reduces the the measurement of emotional exhaustion [27], employees’ quality of life, especially in the depersonalization, and lack of personal stressful system of hospitals, is excessive work accomplishment in the framework of occupational (workload) [22]. Workload assessment is necessary activity. It particularly measures and prevents to measure perceptual demands and to calculate the burnout in professional groups, such as nurses and capacity of individuals to perform additional tasks, teachers, etc [28]. The scoring of items in the as well as to prevent fatigue and human errors and questionnaire is based on a 7-point Likert scale to evaluate tasks in workplaces [23]. (range of score: 0- 132). The reliability of the

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48| IJOH | June 2018| Vol. 10 | No. 2 Rahimpoor et al questionnaire has already investigated by Wheeler deviation of workload and occupational burnout (2011) using Cronbach's alpha between 0.70 and were 58.15 ± 12.9 and 62.65 ± 20.93, respectively. 0.80 and by Akbari et.al (2011) within the range of According to the results of this study, there was 0.85 - 0.94 [29-30]. found no significant relationship between the The NASA TLX questionnaire was first variables of “workload and marital status”, designed by Sandra Hart in the United States “occupational burnout and marital status”, National Aeronautics Organization. The validity “workload and education level”, and “job and reliability of the NASA TLX were tested by satisfaction and educational level”. There was also the Nasl- Seraji et al. in 2011 in a study on the no significant relationship between workload and workload of nurses (α = 0.83). NASA-TLX is a occupational burnout (p> 0.05: Kruskal-Wallis and multi-dimensional approach that offers a general Cronbach's Alpha tests). The workers obtained the score of workload based on the weighted average highest level of workload in terms of efficiency. of six subscales, including mental pressure, Their workload was the lowest in terms of physical pressure, time pressure, performance, frustration. From the perspective of mental effort, and frustration and exhaustion. The score of pressure, physical pressure, time pressure, and weighted workload is achieved by comparing the effort, their workload was evaluated to be scores of each subscale based on pairwise moderate. The relationship between the different comparison method [31]. After completing the variables is shown in Table 2. The results of the t- questionnaire, the stepwise correlation coefficient test showed that there was no significant difference was calculated. The study protocol and its ethical between occupational burnout of single workers considerations were approved by the Applied (with a mean of 67.25±19.49) and married workers Research Council and the Ethics Committee of (with mean 61.77± 21.19). In addition, t-test results Gonabad University of Medical Sciences. showed that the workload of the married subjects After obtaining permission from the was 55.83± 12.89 and the single workers 59.04± authorities of the Welfare Center, the purpose of 12.97 respectively. No significant difference was the study was explained to the participants, and all found between the workload of the married and of them signed the written informed consent form single workers. prior to participation. The participants were also The results of the one-way ANOVA assured of the confidentiality of data and test showed that there was no significant anonymity of all questionnaires. The collected data relationship between workload and occupational were analyzed in SPSS software, version 19. burnout with education level. The workload Descriptive and analytical statistical tests, such as score in the individuals with secondary one-way ANOVA, t-pair, independent t-test, education, diploma, associate, bachelor’s, and Kruskal-Wallis, Chi-square, and Pearson master’s degrees was 63.20±14.94, 59.29±12.86, correlation coefficient with a significant level of 57.81±10.00, 56.57± 12.75, and 58.02±12.19, p≤0.05 were used to investigate the effects of the respectively. The occupational burnout score in different variable on each other. the subjects with secondary education, diploma, associate, Bachelor’s, and Master's degrees was RESULT 62.05±19.59, 72.12±16.66, 59.84±20.35, 56.57± The mean and standard deviation of the 12.75, and 58.02±20.88, respectively. Table 3 workers’ age and work history were 35.3 ± 8.9 and shows the scores of various subscales in the 7.4 ± 7.12 years, respectively. The mean and NASA- TLX questionnaire. standard deviation of daily working hours and Based on the results for burnout and income were 8.3±1.7 hours and 11470± 805 workload of health care workers, it was found thousand IRR, respectively. In terms of sex that the performance subscale had the highest composition, 49 of the 100 healthcare workers were score over other subscales of workload (67.9± female and 51 workers were male. The 23.3). The results showed that the workers with demographic characteristics of the studied nurses elementary-middle school education had the are shown in Table 1. The mean and standard lowest degree of occupational burnout.

Table 1. Demographic characteristics of the subjects Variable Number Percentage Marital status single 16 16.00 married 84 84.00 Education level Associated 46 46.00 BSc 46 46.00 MSc 8 8.00 Employment status Official 22 17.14 Contractual 44 48.57 Internship 34 34.28

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Table 2. Rrelationship between different variables among the workers in the Welfare Organization Variable Work Experience Income Daily Occupational Workload Working Burnout Hours Work Experience R 1.000 -0.083 0.153 0.047 0.027 p-Value ----- 0.412 0.129 0.644 0.005 Income R -0.083 1.000 0.009 -0.083 -0.079 p-Value 0.412 ----- 0.913 0.413 0.433 Working hours daily R 0.153 0.009 1.000 0.255 -0.043 p- Value 0.129 0.931 ----- 0.010 0.669 Burnout R 0.047 -0.083 0.255 1.000 -0.096 p-Value 0.644 0.413 0.010 ----- 0.341 Workload R 0.276 0.079 -0.043 -0.096 1.000 p-Value 0.005 0.433 0.669 0.341 -----

Table 3. Score of workload subscales Perspectives of workload Mean SD Mental pressure 63.40 26.17 Physical pressure 58.75 23.78 Time pressure 60.30 21.72 Performance 67.90 21.33 Effort 61.54 26.31 Frustration and exhaustion 37.05 24.23

The job burnout rate was higher among the most important workload among health workers single workers (67.24) than married workers [35, 36]. However, other researchers, such as (61.77). The results showed that marital status had Sarsangi et al., reported that the subscale of effort no effect on job burnout, which is in line with the had the highest score among nurses [25]. The study by Asgari [32]. reason for such differences may be due to In terms of workload, it can be said that differences in the occupational groups. In this the workers with secondary education had the study, the workload was mainly of performance highest workload. The married workers had the type. highest workload than the single workers. In More than 36% of the nurses participating general, it can be concluded that there is no in the study of Cimiott et al. suffered from high significant relationship between occupational levels of occupational burnout [37]. Some other burnout and workload, as well as between studies found moderate to high levels of occupational burnout and workload with occupational burnout for healthcare workers in the educational level and marital status. Barbosa et al. specialized wards [38, 39]. The reason for this found no significant relationship between difference can be explained by the higher mean age occupational burnout and workload of physicians and work experience (11 years) of the participants [33]. It was also concluded that with an increase in in the present study compared to those participating the work experience, the rate of workload increased in the above-mentioned studies [40]. In other (p-value: 0.005), and with an increase in daily words, burnout is the end result of exposure to working hours, the rate of burnout increased (p- chronic and prolonged occupational stresses. value: 0.01). This could be due to the delegation of Accordingly, burnout is greater among people who responsibility beyond the capacity of workers in the spend more time in a job than those who have just organization, lack of managers' attention to taken a job. employees’ affairs, lack of facilities and In the case of work experience, in the low- opportunities for workers, lack of training, very effect logistic model (1.09), emotional exhaustion difficult working conditions, and consuming much increased with each year of increased work time and energy. In order to combat occupational experience. It can be argued that due to the burnout and workload, it is recommended to “make difficulties of the nursing profession, with sure the workers are physically and mentally fit increasing work experience, healthcare workers' before employing them for the job”, “pay attention tolerance for emotional excitement becomes to the rights of employees”, “create diversity in decreases. According to some other studies, the work”, “use a psychologist or an expert to improve work experience is not related to the dimensions of the employees’ working relationships”, “consider occupational burnout that is consistent to the giving the staff a short break between work” and present study [41-43]. The study by Tabolli et al. “avoid overwork” [34]. In the studies by Safary et indicated that the nurses' well-being and health are al. and Malekpour et al., cognitive stress was found affected by increased working hours per week and to be high workload [44]. In this regard, it can also be

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50| IJOH | June 2018| Vol. 10 | No. 2 Rahimpoor et al claimed that high daily working hours, by experienced burnout. J Organ Behav 1981; increasing workload, cause the creation and 2(2):99-113. persistence of stress. One of the major 9. Wu S, Zhu W, Wang Z, Wang M, Lan Y. consequences of this negative process is the Relationship between burnout and occupational experience of burnout and a decline in stress among nurses in China. J Adv Nurs 2007; psychological well-being. 59(3):233-239. 10. Li, A., Early SF, Mahrer NE, Klaristenfeld JL, CONCLUSION Gold JI. Group cohesion and organizational Given the findings of this study and the commitment: protective factors for nurse importance of the profession of healthcare workers, residents' job satisfaction, compassion fatigue, it is important to address the problems of workers compassion satisfaction, and burnout. J Prof in the Welfare Organization. The relevant Nurs 2014; 30(1):89-99. authorities also need to provide solutions to suit 11. Gaba DM, Lee T. Measuring the Workload of their environmental, management and personnel the Anesthesiologist. Anesth Analg requirements. 1990;71(4):354-361. 12. Emold, C., Schneider N, Meller I, Yagil Y. Communication skills, working environment ACKNOWLEDGMENTS and burnout among oncology nurses. Eur J This study, as part of a research project Oncol Nurs 2011;15(4):358-363. approved in February 2017 at Gonabad 13. Saremi, M, Tassi P. Comparison of fatigue University of Medical Sciences, was financially level, sleep quality and quantity in old and sponsored by the Vice-Chancellery of Research young shift workers. Res Med 2008;32(2):135- at the Health School of the university. The 139. authors greatly appreciate the support and 14. Poncet MC, Toullic P, Papazian L, Kentish- cooperation of the Vice-Chancellor, as well as Barnes N, Timsit JF, Pochard F, Chevret S, the workers at the Welfare Organization. Schlemmer B, Azoulay E. Burnout syndrome in

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